IVF: A Complete Guide to Understanding In Vitro Fertilization

In Vitro Fertilization(IVF) is the main type of assisted reproductive technology(ART). Since the first successful pregnancy in 1976, it has resulted in tens of thousands of live births. As In the most basic terms, IVF involves fertilizing an egg outside of the body – where it can be monitored and kept healthy – and then later inserting it into the uterus. Hopefully, at that point, a pregnancy will occur.

Couples choose to try or are advised to try IVF for a number of reasons, including the followings:

Damaged fallopian tubes (or blocked tubes)

Infertility caused by low sperm count or motility

Ovulation disorders (including uterine fibroids or ovarian failure)

Genetic disorders or infertility for other reasons.

If you’ve had your fallopian tubes removed in order to decrease your risk of ovarian cancer – or if you had them removed because you didn’t plan on having any additional children, you may also be considering IVF. Because fertilization takes place outside the body (without the use of fallopian tubes), it’s an option for women who’ve had surgery to remove them.

But before you get started, you may have hundreds of questions, which is very normal. Pregnancy is a big step, and choosing IVF involves many decisions you’ll have to make. Learn about how it came to be, how it works, how much it costs, and typical success rates.

A Brief History

When To Began

The very first successful IVF pregnancy occurred in 1976 to parents Leslie and John Brown. Patrick Steptoe and Robert Edwards – a gynecologist and a professor – were the first to make it work, though attempts had been made much longer before the 70s.

Steptoe and Edwards’ IVF process was breakthrough for women who were unable to conceive naturally, due to damaged fallopian tubes. That is actually the reason that idea was designed. For women with damaged Fallopian tubes, pregnancy can be difficult to impossible.

What Has Changed Over the Years

A lot has changed since 1976 when Steptoe and Edwards created the first successful IVF pregnancy. There have been changes in the procedure, the safety, and even the use of anesthesia in the process.

When Steptoe and Edwards were performing IVF, laparoscopy was necessary in order to harvest the eggs. Laparoscopy is still a common medical procedure used today, and is minimally invasive. But it requires anesthesia, which has some risks associated with it. Today, the harvesting is done in a much different way, and requires less anesthesia and money.

Another important change over the year that women are now given hormone treatment for IVF. It used to be that the process was tracked naturally, but it was far less successful.

In fact, the very first IVF pregnancy is considered somewhat serendipitous because the doctors had not used intentional timing at all with the intention of the fertilized egg. Today, it’s much clearer how important timing is!

IVF Today

Fast forward almost 40 years from the first conception, and IVF has resulted in thousands of successful pregnancies. Not only is it safer today than it used to be, but it costs less. Doctors use less anesthesia, less invasive procedures, and a much more scientific – and successful – process. All of that means reduced costs for parents who are planning to use IVF to conceive.

If you are unable to conceive naturally, IVF is now an option, whereas, less than fifty years ago it wouldn’t have been.You have several ART options now, in fact, but it is still the most popular among them.

How IVF Works

Preparing for IVF

If you decide to use in vitro fertilization to conceive, you’ll need to be prepared for multiple tests, procedures, monitoring, follow-up, medication, and a variety of emotions. In the beginning, you might be asked to take fertility drugs. The fertility drugs will make sure that there are plenty of healthy, viable eggs produced in the ovaries, for use later with the procedures.

You will likely also have your ovaries monitored and tested with an ultrasound. It’s important that they are healthy and able to produce eggs. In addition, your doctor will monitor your hormone levels and provide medications to balance them, as necessary.

All of that is just the first step – the preparation IVF stage. Once you’re past this part of the process, eggs will be retrieved. Doctors do this with a process called “transvaginal oocyte retrieval.” While the name is complicated, the process isn’t. You’ll be given some medication to make it comfortable for you, and then the doctors will insert tiny needle that’s hollow, into the ovaries and remove the eggs. Today, doctors use sonogram technology to guide them.

You’ll also be asked to provide sperm so that the eggs can be fertilized with it. Depending on a number of other factors, a doctor tests the sperm and prepares it for fertilization.

Transfer and Implantation

What happens next IVF stage depends on a couple of things. If the sperm is already highly motile, the sperm and eggs are combined in a dish, and hopefully fertilization takes place without any additional help. If not, though, there are still options. Sometimes, a doctor will directly inject sperm into one or more eggs to encourage the fertilization. After the eggs are fertilization, doctors monitor them. If they become fertilized, they’re considered embryos and ready for the next step.

It takes three to five days, usually, for embryos to be ready to be used. Doctors refer to this important process as “embryo transfer” because this is when the embryos are transferred from the tube into the uterus. If successful, the result is a pregnancy.

IVF Timing

With successful in vitro fertilization, timing is everything. The process above was made simple for the purposes of this brief guide, but it’s actually much more involved than that. Pregnancy itself is a matter of sheer timing. It can only happen when the body is ready to become pregnant, which is during a small number of days in any given month.

When you first set out to use in vitro fertilization, doctors are going to restart your hormone cycle so that they can more easily manage the pregnancy. They call this process Suppression, and it really just means suppressing your natural ovarian function so they can time it better and so that you produce more eggs. Twenty-one days before IVF starts, you’ll be put on medication that will start your cycle all over again. After that, doctors will inject some medication to help you produce multiple eggs that can be fertilized (normally you only produce one).

Timing – and the patience it requires – it sometimes the most difficult part of in vitro fertilization. But doctors who specialize in IVF have taken a lot of training and education to know how to properly time everything, and you will also be educated in the whole process if you choose this route.

IVF Failure

As with any method used to conceive, IVF doesn’t always work. The reasons will be different for each round, even subsequent rounds with the same couple. Sometimes, an IVF failure can help uncover other issues with the eggs or sperm that can be address in later rounds.

Dealing with failure can be difficult because so often, couples go to really great lengths to make it happen. It’s a big expense and is sometimes emotionally or psychologically difficult. Because of the potential for failure, consider counseling before or after IVF to help you stay focused, optimistically, and emotionally healthy.

Reasons for IVF failure. This list only covers a small number of reasons, but hopefully it provides you some additional insight into the process:

Some embryos die after implantation.

Many embryos – sometimes all – do not live long enough to be transferred.

Issues with uterine lining can prevent implantation or cause it to fail.

The important thing to remember is that usually, the issue isn’t the sperm OR the uterus OR the insertion technique used. Implantation is a natural event, and IVF only ensures that a fertilized egg will reach the uterus; it cannot guarantee successful implantation. However, a good fertility doctor can help uncover the reasons for failed treatments and help you get additional treatment.

How Much Does IVF Cost?

A number of factors influence how much IVF costs overall. Some costs will be out of pocket, while some might be covered by insurance. Additionally, some patients might be eligible for certain types of financing. This section provides just a brief look at the typical costs and how they are paid.

At a glance, IVF costs anywhere from $8,500 for a single round, to $20,000 or more for multiple rounds. Please note that these are ballpark estimates – not exact prices. Each doctor’s office or clinic will charge fees specific to their particular program.

Out of Pocket Costs

Regardless of whether you have insurance or financing, there may be some out of pocket costs for IVF that you should keep in mind.

The cost of testing and/or diagnosis

Counseling before or after treatment

Cost of travel to the IVF clinic you choose

Consultation fees

Pain medications not covered by insurance

Labs or sonograms not covered by insurance

Of course, if you do not have any insurance at all to cover the IVF treatment, you’ll also pay out of pocket for the procedures itself, the cost of each visit to the clinic, the medications and hormone treatments, and doctor’s office charges.

Costs Covered by Health Insurance

Today, some employers include IVF treatments in their health plans. This encourages more people to stay with the company. If so many people are choosing IVF to conceive, that means that there are many people out there in need of coverage.

State Mandates. Currently, fifteen states require insurance carriers to cover the cost of infertility treatments in their health insurance plans, or to offer coverage at an extra cost. Those states are: Arkansas, California, Connecticut, Hawaii, Illinois, Louisiana, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, Texas and West Virginia.

Typical coverage. Even if your insurance carrier does provide coverage for IVF, it may only include certain things. For example, some insurance carriers cover the cost of testing and diagnosis, but some don’t. Some insurance carriers will only cover the treatment and medications – which means that you will have to pay for the testing for infertility. The upside of that is that IVF is only one of several options for assisted pregnancy. Paying for a test independent may keep your options open. You should also be aware that some insurance carriers have limits as to how much treatment they will cover. Some plans are even specific about the number of rounds they will pay for – one round, two rounds, multiple rounds, etc.

Financing

If you don’t have the money to pay for IVF out of pocket, and insurance isn’t an option for you, there is still hope. Some companies provide special financing. Additionally, IVF clinics and providers know that it is expensive and difficult to pay for, so they may have payment options available for you to choose from.

If you have a high credit line, you can charge the cost of your treatment and pay it down over several months. Or, you can opt for services like fertility loans. You can use these loans for IVF treatments as well as other types of fertility procedures. That way, if you need to try multiple ways to conceive, you can.

While it’s a last resort, some people choose to pay for IVF by selling assets, such as cars, homes, or high value items that they own. Another option to take an early withdrawal from a retirement fund. Some funds do allow for a withdrawal in order to grow a family (fertility treatments or adoption).

IVF Success Rates

What are the odds of getting pregnant?

Many people who consider IVF as an infertility treatment find themselves asking, “Does it even work?” “What are the chances that we are going to get pregnant?”

Those are very normal questions you should ask. Don’t just research the answers online. Ask your doctors, too, and any IVF clinic you choose to go with.

What you should know up front is that IVF often takes more than one round to be successful. That may be disappointing to hear, but it is always better to go into an IVF cycle with the understanding that most couples require multiple rounds. You should remain optimistic while still keeping yourself grounded and educated on the process.

According to CDC and SART.org, nearly 70% of women require more than one round of IVF to conceive. Keep that in mind when you’re planning, choosing a clinic location, and preparing for financing it. On the other hand, while 70% is a big number, 30% success rate on the first round of IVF is incredible – and attainable. Essentially, you have nearly a one in three chance of getting pregnant on your first round.

Increasing the Odds of IVF Pregnancy

Age is a factor in IVF just as it is in natural conception. Younger women have higher success rates than older women do, but the rates are not wildly different as you might think.

At the same time, other factors increase the success rate of IVF. For example, not all participants can or do use their own eggs. In some cases a donor egg is used instead. According to SART, the success rate of donor egg recipients is about 45%.

You’ll increase your odds of getting pregnant if you commit to IVF as a series of treatments, rather than a one-time event. While you could become pregnant the first round, the odds are more in your favor if you commit to more than one round.

Keep in mind that each clinic or doctor may have their own success rates. Some programs are very different from others – they may use a different technique, or prepare you for IVF in a different way, or do certain things to try and increase the odds of pregnancy.

Consider Several Programs Before Deciding

That’s why you should talk to your potential IVF doctors and get to know the programs really well. Ask if they specialize in couples with situations just like yours. Some may specialize in male infertility and have procedures to address that, while others may specialize in a different issue.

You may want to talk to several doctors or clinics before committing. You may also want to look at options out of state. For some couples, traveling long distances to have a successful pregnancy is worth it. It also may be that a doctor who specializes in your age group or issues is willing to take patients from out of state (though there may be additional costs associated with this).

Of course, ultimately you have to think about your own circumstances and what makes the most sense for your family, needs, and ability to pay for IVF.